The Stroke Team is the engine of the UCSD Stroke Center and the SPOTRIAS proposal, organized to respond immediately to acute stroke. The UCSD Stroke Team is recognized intemationally: we consistently lead recruitment into acute intervention trials. We propose to expand the Team's availability and to show that patients can be treated within 2 hours of symptoms onset. This Core has 3 specific aims: 1) To respond to code stroke 24 hours per day, 7 days per week. To do this, we will continue our current team management, enhanced with SPOTRIAS sponsored research projects. 2) To treat 12 patients per year within 2 hours of stroke onset. Prior data collected here and elsewhere shows that patient enrollment times tend to cluster near the stated upper limit for time to treatment. By moving the accepted 3-hour time window up to two hours, we should obtain even better response rates than expected from typical t-PA use. Further, the procedures required to treat patients within a 2-hour window will have collateral benefits to other patients and SPOTRIAS research trials. 3) To Collect, Review, and use QA data to improve delivery. Our pilot data shows that we can document several important Stroke Code indicators, including door-to-physician, door-to CT scan, door-to-Neurologist, and door-to-needle times. We will use the QA data collected at UCSD and at other hospitals in our network to identify barriers to 60 minute door-to-needle times. This will be coordinated with othere SPOTRIAS centers nationally to assure coherence.